Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ramsbury and Wanborough Surgery on 16 December 2015. We visited both practice locations during the inspection. Overall the practice is rated as outstanding. Specifically the practice was outstanding for the delivery of responsive and well led services and good for delivery of safe, effective and caring services. The rating of outstanding applies to all population groups.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were optimised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, when a significant event was reviewed the learning was shared with four other practices in the area.

• Feedback from patients about their care was consistently and strongly positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example emergency admission beds were used at local nursing homes and a carers coordinator worked with the practice.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, when patients commented that the branch surgery needed improvement the practice installed automated doors and provided a new chair in the nurse treatment room.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• Provision of a bus service to bring patients from rural locations to their appointments.

• Elderly patients living in care homes had their needs reviewed by the GPs in conjunction with a specialist in care of the elderly on a monthly basis.

• Access to emergency care beds for the elderly in local nursing homes reducing reliance on hospital services for care of the elderly.

• Both the main and branch practices were open on Saturday mornings offering pre-booked and on the day appointments. The dispensary’s at both were also open on Saturday morning. This meant patients who were unable to collect their medicines during the week could do so on Saturday morning.

• Provision of local services that enabled the GPs to manage demand on hospital care and make services more accessible to patients. The practice achieved consistently low rates of referral to outpatients and attendance by patients at Accident and Emergency were also lower than average.

• The practice offered placements to nurses in training. The lead practice nurse was a trained mentor.

• Provision of ECG tests, including 24 hour ECG monitoring, in the patient’s home.

• Consistently above average patient feedback about staff being kind and courteous and being able to access appointments.

• Learning from significant events was regularly shared with four other practices in the locality.

However there were areas of practice where the provider should make improvements:

• Install a secondary means of monitoring the temperature of medicines fridges.

• Further promote the benefits of flu vaccinations for patients in at risk groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice